Welcome to my blog. HIV prevalence is not a reliable indicator of sexual behavior because the virus is also transmitted through unsafe healthcare, unsafe cosmetic practices and various traditional practices. This is why many HIV interventions, most of which concentrate entirely on sexual behavior, have been so unsuccessful.

Tuesday, November 29, 2011

The Global Fund for AIDS,
TB and Malaria has dried up. Perhaps not for ever, but for long
enough for us to realize that providing increasing numbers of people
with increasingly expensive drugs for decades may not be wholly
sustainable.

If any effort had been
made to reduce transmission of HIV (or even TB or malaria, although
they do seem like a bit of an afterthought) over the last 10 years,
the costs of 'universal access' to antiretroviral drugs might have
gradually become achieveable. But with more people being infected
than being put on drugs, the Fund has presided over ten more years of
missed opportunities in the field of HIV prevention.

There's lots of talk about
treatment being prevention, on the grounds that
those on treatment are less likely to transmit HIV. But that is still
just talk, and the levels of testing, treatment, support and
monitoring required to effect such a program are probably beyond the
means of all HIV funding put together. Treatment is vital, and
greater access to treatment may help prevent some infections, but it
will never obviate the need for effective prevention strategies.

So
Kenya is being advised to "Seek
Alternative Ways of Funding Healthcare", as no new programs
will be funded for the next two years. Ten years of ignoring health
systems and diseases that were not considered sexy enough now means
there is a lot of catching up to do and no money to do it with. For
all the billions that have gone into HIV, African health systems have
little to show for it. It's late in the day for a decision to start
to see HIV for what it is, a disease, one among many. It's also late
to decide that "it is time to dismantle the many parallel HIV
programmes created mainly to compete for donor funding but which are
unsustainable".

Uganda
finds that the "Aid
Cut [will] Affect One Million HIV Positive Citizens".
Apparently the country had massive plans to eradicate HIV, even more
massive than the ones that didn't eradicate it over the last twenty
years. There were plans to put most people on treatment, especially
mothers and children. But the virus appears to be making a comeback
in certain sectors of the population, and has been doing so for some
years. Exactly what have they been doing?

The
Ugandan Government is also "Advised
to Use Local Resources to Fight Aids", which would probably
be good advice if such local resources exist. But African governments
might also be well advised to form their own health strategies, with
HIV fitting appropriately into those strategies, rather than
remaining apart from health and other social services and completely
dominating most agenda, as it has done for so many years. The various
organizations and institutions that have been sucking on the HIV
nipple will need to diversify, downsize or disappear.

None of this sounds like a
reason to celebrate. But it is a good time to change, if African
governments decide to do so. It may now be up to them to identify the
main drivers of the virus, to assess the relative contribution of
each mode of transmission and to decide on the most appropriate ways
of preventing the further spread of HIV. If the donor community is no
longer paying, perhaps Africans will notice that their sexual
behavior is not that different from that of non-Africans. Perhaps the
way will be open for programs that rely less on expensive
technologies and an unwarranted assumption that HIV transmission all
a matter of sex.

Because currently, things
are great for the pharmaceutical industry and the HIV industry in
general. Not without some serious lobbying, I'm sure, but everything
has been going their way for years. Donor funding has poured into
their coffers and every year a new scheme is dreamed up to increase
the tonnage of drugs shipped to poor countries, where far more people
are dying for lack of clean water and decent levels of nutrition than
HIV.

Perhaps
now, the 'experts', the ones that African countries couldn't do
without, will have to go home and find a job in healthcare, with the
appropriate retraining, of course. I believe it's called 'task
shifting'. Africans will not suddenly start losing out as a result of
Global Fund cuts, they have been losing out for years. But the HIV
industry will lose out. Expect
a lot of emotive pleas, ostensibly for 'dying Africans', but hear
those pleas for what they really are: self interest.